STAMPED & REDACTED LUTHERN SOCIAL SERVICES OF THE SOUTHWEST.PDF

MARICOPA COUNTY
Department of Finance

301 West Jefferson, Ste 960
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: April 21, 2022
To: Clerk of the Board
From: Nadine Higuera

Department of Finance

Subject: Affidavit - Replacement of lost Warrant

Please find attached 1 Affidavit for a reissue warrant to be included on the next

available Board Agenda.
e The attached items have been researched to ensure the warrant in
question have not been cashed or previously re-issued.

e The original warrant has been lost

Please call me at if you have any questions. Please return the approved

Affidavits to my attention in the Department of Finance, Suite 960.

Thank you.

Re: Lutheran Social Services of the Southwest D220 IN doc 22"28757

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/Claim Form

This application is for: R] Duplicate or I] state-Dated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this form correspond to

COUNTY OF MARICOPA numbers on the Instruction sheet which is
paae 2 of this form.

(1), being first sworn, upon oath deposes and says:

LUTHERAN SOCIAL SERVIGES OF THE SOUTHWEST

Name/Ciaimant

On or about 95-Jan-2022 (date)(2} a warrant/check was issued to the
above named person/entity in the amount as stated below. Such warrant/check was
either never received or was subsequently inadvertently lost or destroyed and there is
no reasonable probability of its being found or presented for payment, or it was not
presented for payment within one year after the date of issuance.

Therefore, under penalty of perjury, claimant hereby affirms that this claim is correct
and the amount shown is due and owing, and the applicant requests that a replacement

warrant/check be issued to him/her in the sum of $9,640.50 -3)

Signed: MN. @t—— (4)

Note; Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

(5) Subscribed and sworn to before me this | EY" day of Apri\ __ 20. 92.

NOTARY PUBLIC

My commission expires:

tober OS, 209S

(seal)
Warrant/Check Number
{Check number 13040106751
Original Date of Issue
L 9 (if known) (7) 05-Jan-2022
Reason for original issue of Warrant/Check (8): ipa

01 Payroll ,
(1 For Services or Goods furnished

C1 Treasurer’s refund/payment
= Other: Original check presumed lost

Lutheran Social Services of the Southwest D220 IN doc 22*28757

a Lutheran

=I Social Services
of the Southwest

April 18, 2022

I, George Diflavis, authorize Maria G. Gonzalez Account Receivable Specialist to execute an
affidavit on behalf of Lutheran Social Services.

Yours Truly,

i

f

George Diflavis
Finance Director

Dounty
#616713
on Expires
2025

=

2502 E. University Drive, Suite 125, Phoenix, AZ 85034
(488) 396-3795 @ Fax: (480) 325-3643 © www.lss-sw.org

TREASURER OF MARICOPA COUNTY

WARRANT NUMBER

COUNTY EXPENSE WARRANT
AICS PHOENIX, ARIZONA 3010106751
See
7 ESEPAIESES DATE
— q
( ( 61-05-2022 91-2/1224
C6 UNG
Five Thousand Six Hundred Forty And 50/100 Dollars
$5,640.50
PAY TO THE ORDER OF
AMOUNT
Lutheran Social Services of the Southwest
Void After
365 Days

For Questions - or email NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE

RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANY DATE | WARRANT AMOUNT
YOUR RECORDS

Lutheran Social Services of the Southwest 3010106751 01/05/2022 $5,640.50
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
DO D220 220000017742. |220000017684 5,640.50

LSS-NOV21 HCD-22-082 LUTHERAN SOCIAL SERVICES NC

Nadine Higuera (FIN)

From:

Sent:

To:

Ce:

Subject:
Attachments:

Categories:

Hello

Vendor VCO000007086 didn’t receive warrant 3010106751. Can you assist the vendor with reissuing warrant? Thank

You!

Eddie Contreras
Accounting Specialist
Administration Division

From: Maria Gonzalez <
Sent: Tuesday, April 12,

To: HSD Finance Folder
Cc: Erika Gonzalez <

HSD Finance Folder

Wednesday, April 13, 2022 9:26 AM

FIN AccountsPayable

Erika Gonzalez; Lori Francisco (HSD); ‘Maria Gonzalez’; HSD Finance Folder
RE: MCHC LSS INV NOV 2021- missing payment

Warrant 3010106751 November 2021 .pdf

Nadine

Maricopa County Human Services Department

Desk: Cell: | Fax.

2022 2:46 PM
; Lori Francisco (HSD) <

Subject: RE: MCHC LSS INV NOV 2021- missing payment

Lori—sorry for the late response on this matter, I've been out of the office. In regards to the November payment we do ©
need you to reissue the check, we never received it. What or where is the paperwork that we need to fill?

Thanks in advance

=e iutheran
HP Social Sarviees

of the Southwest

Maria G. Gonzalez| AR Billing Specialist

From: HSD Finance Foldei -

Sent: Wednesday, March 2, 2022 12:04 PM

To: Lori Francisco (HSL,

Ce: HSD Finance Folde:

Subject: RE: MCHC LSS INV NOV 2021- missing payment

Hey Lori

The 2 checks were returned to OBF as undeliverable. The October and November checks were mailed on 2/8/2022. It
would have been sent to the . The check for October did clear the
treausers office. If they didn’t receive the November check and they need it reissued. The vendor will need to work
with OBF to have the check reissued. There is paperwork the vendor fills out and sends to OBF.

Eddie Contreras
Accounting Specialist
Administration Division

Maricopa County Human Services Department

From: Maria Gonzalez -

Sent: Tuesday, March 1, 2022 2:08 PM

To: Lori Francisco {(HSD! <

Ce: Sebatakane J. Kakule < » HSD Finance ruider <
Subject: RE: MCHC LSS INV NOV 2021- missing payment

Hello Lori- I’ve attached the updated invoices that require payment.

Let me know if you need anything else.

Thanks in advance

é Maria G. Gonzalez] AR Billing Specialist
ay, ii Lutheran Social Services of the Southwest
' Soaial Services
of the Soutinwest

From: Lori Francisco (HSD)}

Sent: Tuesday, March 1, 2022 1:52 PM
To: Maria Gonzalez <

Cc: Sebatakane J. Kakule < ; HSD Finance Folder < :
Subject: RE: MCHC LSS INV NOV 2021- missing payment

Hi Maria,

The January invoice has the following address:

Subrecipient "Lutheran Social Services SW

Address: ee pe
City/State/Zip: a

Contact Person: Sebatakane J. Kakule

Phone Number:

E-mail Address: — ate,

Please ensure all future invoices contain the University address so the payment gets sent to that address. If this is the
address listed, we cannot process because you updated the system to the university addresss. Please correct and email
back to me as soon as possible.

Thank you
Lori Francisco
Grants Accountant

Housing & Community Development
Administration Division

Maricopa County Human Services Department

HUMAN SERVICES.
DEPARTMENT

From: Maria Gonzalez

Sent: Wednesday, February 23, 2022 10:13 AM
To: Lori Francisco (HSD) <

Ce: Sebatakane J. Kakule

Subject: FW: MCHC LSS INV NOV 2021- missing payment

Hello Lori- thank you so much for the payments, we’ve received payment for the month of October and December. We
are still missing payment for November not sure if you received this email, at that time | sent it to Scott not sure if he

was still with the company.
Let me know if you have any questions.

Thanks in advance

E Maria G. Gonzalez| AR Billing Specialist
EEE ucheron Lutheran Social Services of the Southwest
| Social Services
ef tha Southwest

From: Maria Gonzalez
Sent: Wednesday, December 15, 2021 10:50 AM
To. .

Cc: Angelica Gerardo ;
Subject: MCHC LSS INV NOV 2021

Good morning -.I’ve attached the Invoice for November, please advise If anything else is needed.

Thanks in advance & happy holidays

Pe | Maria G. Gonzalez] AR Billing Specialist

em theron Lutheran Social Services of the Southwest

VY Sccial Services _ 7
oft the Seutharest